Clevidipine
Cleviprex
Ultra-short-acting dihydropyridine broken down by esterases in blood and tissue — the half-life is 5 minutes and the effect can be steered minute by minute. Selective for smooth muscle in the vessel wall: lowers systemic vascular resistance without affecting contractility, conduction, or filling pressure.
Given in a lipid emulsion containing soy and egg — contraindicated in hypersensitivity to these, in defective lipid metabolism, and in severe aortic stenosis. Requires continuous blood pressure monitoring.
Dosing in adults
| Indication | Regimen | Comment |
|---|---|---|
| Hypertensive crisis | Starting dose 1–2 mg per hour iv, doubled every 90 seconds until the target is approached | rapid titration possible thanks to the short half-life |
| Usual therapeutic dose | 4–6 mg per hour iv | most patients are controlled in this range |
| Perioperative hypertension | 1–2 mg per hour iv, titrated to target pressure | pre-, intra-, and postoperatively |
| Maximum dose | 21 mg per hour iv | the lipid emulsion limits treatment to 1 000 ml per day |
No dose adjustment. Metabolised by esterases, not by the kidney.
No dose adjustment. Not metabolised by the liver.
Insufficient documentation in children. Not used routinely.
Avoid in hypersensitivity to soy or egg and in severe aortic stenosis — the rapid afterload reduction can cause circulatory collapse in a patient with fixed outflow obstruction. The lipid load limits treatment duration in patients simultaneously receiving propofol.
Pharmacokinetics
- ONSET
- 2–4 minutes
- DURATION
- 5–15 minutes
- t½ (initial)
- 1 minute
- t½ (terminal)
- 15 minutes
- Vd
- 0,17 l/kg
- PROTEIN BINDING
- > 99 %
- METABOLISM
- Esterases in blood and tissue
- EXCRETION
- Renal and faecal (inactive metabolites)